- Stony Brook University (Stony Brook, NY)
- …may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR from the ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...Documents over utilization of resources and services. + All Medicare cases are reviewed for level of care on… more
- Intermountain Health (Albany, NY)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... optimization of reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and Hospital Acquired… more
- Molina Healthcare (Albany, NY)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Amgen (New York, NY)
- …through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested ... to HCPs on how the products are covered under the benefit design (Commercial, Medicare , Medicaid) + Serve as a payer expert for defined geography and promptly… more
- Ellis Medicine (Schenectady, NY)
- …by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and social workers for ... in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home care, payer, or… more
- Stony Brook University (East Setauket, NY)
- …following, but are not limited to:** + Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied ... collection agencies. + Identify issues and patterns with claims/insurance companies and review to increase revenue and prevent unnecessary denials. + Assist the… more
- Stony Brook University (East Setauket, NY)
- …following, but are not limited to:** + Prepare and submit hospital claims. Review denials. Investigate coding issue. Audits. + Follow-up on rejected or denied ... collection agencies. + Identify issues and patterns with claims/insurance companies and review to increase revenue and prevent unnecessary denials. + Assist the… more
- Elevance Health (East Syracuse, NY)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more
- Molina Healthcare (Buffalo, NY)
- …needed + Primary point of contact for the internal partners, ie Medicare Administration, Compliance and Health Plan Operations. Coordinates and facilitates meetings ... processes and established guidelines; provides appropriate follow up on peer review findings + Identifies, defines and communicates opportunities for improvement to… more
- Independent Health (Buffalo, NY)
- …Independent Health policies, summary plan descriptions, member contracts, and Centers for Medicare and Medicaid Services (CMS) guidelines for all lines of business. ... managers, attorneys, other insurance companies, regulatory agencies (ie Centers of Medicare and Medicaid) and internal departments effectively. + Identify and… more